Saturday, January 18, 2014

The Things We Do

I sit here, not tired. Tired doesn't even begin to describe it. Exhausted. Bone-tired exhausted. I sleep every night. Sort of. I can get to sleep - a little quicker with a modest snifter of cognac, but I can't stay asleep. I wake up. Not just a slightly dreamy roll-over, full-on awake. Not just once, but three, four, five, six, sometimes even ten times a night. Every 45-60 minutes, I'm wide awake. I have to pee, my butt muscles are screaming at me to change positions, my shoulder is crying from the pressure of sleeping on it when it's still not healed. 

This morning we went to the reproductive endocrinologist again for another endometrial biopsy. This is the fourth? fifth? Honestly at this point I've lost count. I had one after the first failure, then I had several more trying to confirm that we'd gotten rid of a chronic inflammatory condition discovered after the first one, and then looking at whether the new drug protocol was working right in several trial cycles.

We did another two-embryo frozen embryo transfer IVF in early December and got the negative test on the 12th. We thought we'd cleared all the issues that we'd had going on during the fresh round and the cycles leading up to this.

The only thing I didn't know about the time, was that the doc wasn't entirely happy with what they saw on the last endometrial biopsy. Progesterone that occurs naturally or in our case, added through drugs, has several effects on the endometrial lining that make it an attractive place for an embryo to embed and begin growing. Apparently mine didn't look as happy and inviting as it should have last time - though all other signs were good, so he chose to proceed with the transfer.

I trust my doctor, so I don't know that I'd have made a different decision than that if I'd known, and honestly it's pointless to debate the idea.

We have one frozen embryo left. One last chance to get this done - or we're out. I don't have another $28-$30,000 to do another donor round short of winning the lottery, we've tapped all the resources we have access to at this point.

So this time around, we have to get things as perfect as we possibly can. So I've spent a full cycle on all the drugs, plus added Crinone - progesterone suppository gel, so nearly double the progesterone most IVF patients get during a cycle. Usually it's just intramuscular shots of progesterone oil, which is just a joy ride in and of itself. 1.5 inch 22 gauge needles in alternating butt cheeks at 4 or 5 in the morning, depending on when the Man has to be at work each day. I'm bruised and feel like I've been beaten repeatedly with a 2x4 across the ass every day.

I'm already on double the amount of trans-dermal estrogen with the patches (I wear two rather than one) - and instead of twice daily oral estradiol, I take it vaginally to help with absorption because apparently with my rearranged gut I wasn't getting enough of it through my digestive tract. Where a normal estrogen blood level for a pre-menopausal woman is 20-375, my levels have been running at 1400-2100 depending on how far we are into the cycle. The blood progesterone level isn't so much in question now although it's likely to be huge, but we're looking at the evidence in the lining from the biopsy today.

The sleep issues are, at least in good part, attributed to those massive hormone doses, and unfortunately sleeping pills are not an option during all of this. I spent quite a bit of time after the Nightmare sleeping with the assistance of Ambien, and dear God do I miss it. I'd trade 9 hours of my alleged sleep for 5 uninterrupted hours of Ambien-fueled sleep any day. 

So today I took another 3 inch needle internally for the local anesthetic before the biopsy - I'm thankful I don't have to see this part of it - knowing how long the ass needles are is bad enough. If the anesthetic really is reducing the pain, I'm not sure I'd want to know how much it really hurts, because honestly even with it, it hurts like a motherfucker. Hurt like a motherfucker squared is not really something I care to do.

So we wait now for the pathologist to take a look. The senior pathologist - since he and the doc reviewed my sample together last time. Doc is anticipating this will come in by Wednesday. Thankfully, I've been relieved of having to do the IM shots for the next few days, and I can give up the vaginal estradiol as well until the results come on. Should the sample be sufficient, we'll stop all the other drugs, let me have a period, and start it all up all over again. If the results are as desired, we'll do about 2 weeks on the two estrogens, another round of ultrasounds and blood work to check things out, and then both forms of progesterone again leading up to the final transfer.  If the results aren't as desired, he'll have to figure out another way to improve the progesterone action - which will mean another full test cycle.

In deference to my bruised ass, he did offer me a rest cycle, but there is something to be said for back to back medicated cycles that can encourage my body to get with the program and make a nice comfy nest for embryos. So despite the bruising and pain, I chose to have him go forward with whatever will become of the next cycle - another test or the real transfer.

I question my sanity in continuing this regularly - but I'd never stop questioning whether we could have success if we didn't see it all the way to the end.

I know success will ultimately lead to far more sleeplessness - pregnancy impacts it, having a newborn of course does, I just - I don't know. It's hard to consider it "worth it" right now - instead it's a barely tolerable side effect.

The things we do...

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